Diabetes Simplified: Urine Microalbumin
Why getting a microalbumin test is crucial to your health
By Wil Dubois
There's a lengthy list of things you need to do each year, beyond changing the batteries in your smoke detector, but one of the most important to your diabetes health is also the easiest, and that's to get a microalbumin test.
There are no needles involved, and no blood. All you have to do is unzip your pants and pee in a cup. What could be easier?
The microalbumin test is the canary in the coalmine for your kidneys, which are at double risk as a person with diabetes. High blood sugars can damage kidneys; as can high blood pressure, which is common in people with diabetes. This simple pee test can warn you of trouble at the earliest point. This matters because the problem with kidneys is that unlike most of the structures in the human body—that can either re-grow, self-repair, or be repaired by surgery—damaged kidneys stay damaged. They don't recover. They don't grow back. They can't be fixed.
The kidney is so important to your very survival that nature gave you a spare, just in case one gets hurt. Of course, the problem is that sugar or pressure damage is not asymmetrical. If your blood sugar cooks your kidneys, they'll both be damaged at the same time. Nature's plan was to protect you if you got gored by a wild boar and lost one kidney. (Hey, it could happen.) Nature didn't plan so well for diabetes.
What is microalbumin?
So what is microalbumin in the first place? It's a protein. A verrrrrrrry small protein. And that's its value. It's the first thing that will slip though the kidney's filters if they are beginning to break down, so the presence of microalbumin signals the very earliest signs of kidney damage.
Your kidneys are elegant, complicated filters that take bad stuff out of your blood and keep the good stuff in. When the kidneys get damaged by elevated sugar or pressure, holes get torn in the filters. You can picture them as looking like Swiss cheese. If you have Swiss cheese kidneys, they can no longer function, and to stay alive you have to go on dialysis, which uses a big machine to do the job your kidneys used to do. This, by all reports, sucks big time.
However, the good news is that between healthy kidneys and Swiss cheese kidneys, you can have kidneys that look more like Baby Swiss, with lots of little holes. The kidneys still work, but they are damaged. We use the microalbumin test to let us know that we're in this no-man's-land between kidney health and kidney failure.
Oh. That didn't sound like very good news, did it?
Well, my point is that at this juncture, there is still time to change your health destiny. And that's why we run the test. If trouble is on the horizon, we want to know in advance. There's no second chance with the two kidneys; but we can stop the damage in its tracks and keep it from getting worse, so long as we know that trouble has started.
When is it done?
For type 1s, the test should be run every year beginning five years after diagnosis. Why? Because it takes at least five years of elevated blood sugar to damage the kidneys. It's a waste your money, time, and I guess your pee, to do it any earlier.
For type 2s, the test is run once a year starting the day of your diagnosis. Why the difference? Because by the time most cases of type 2 are diagnosed, the blood sugars have been elevated for a decade. Sadly, many type 2s are diagnosed with at least modest kidney damage at the same time they are diagnosed with diabetes.
Unlike some blood tests, you can eat and drink normally before the test. Well, I guess you might want to drink a bit more so the doctor's nurse doesn't glare at you when you tell her you don't have "to go."
What's a passing score?
There are several flavors of the test, so be sure to talk to your doctor about your results to make sure you understand them, but generally speaking microalbumin of less than 30 mg is considered to be "normal" and the kidneys are healthy.
Between 30 and 300 mg is classified as microalbuminuria, or early kidney damage. According to the National Kidney Foundation, one in three people with diabetes has microalbuminuria.
Above 300 is albuminuria, also known as really bad news.
If your score is high, your medical team will also check for full-sized protein in the urine, the marker for Swiss cheese kidneys.
What if I flunk the Microalbumin test?
If you flunk, you generally get a re-test in a few weeks or months. This is because there are a few things that can throw the test off, giving what's called a false positive. Some of the common causes of false positives are urinary tract infections, fever, antibiotics, or intense exercise before the test. Smoking can cause a false positive, so there's one more reason to quit. A less common cause of a false positive is rolling a Subaru Forester on a snowy road on the way to the doctor's office. This happened to my wife. Her next test was fine. The car was a total loss and had to go on dialysis.
If you flunk the test a second time you get a diagnosis of microalbuminuria. In addition to being at risk for kidney failure, the Framingham Study showed that elevated urine microalbumin increases the risk of cardiovascular disease. And not surprisingly, I suppose, elevated microalbumin has been liked to shortened lifespans.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...